Provider First Line Business Practice Location Address:
441 W PATRIOT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15501-1529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-445-7310
Provider Business Practice Location Address Fax Number:
814-445-3409
Provider Enumeration Date:
06/23/2009